CHAPTER ONE

1.0     INTRODUCTON

1.1     BACKGROUND OF THE STUDY

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar level over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger (WHO 2014). If left untreated, diabetes can cause many complications. Acute complications can include diabetics ketoacidosis, hyperosmolar hyperglycemic state, or death (Kitabchi AE, Umpierrez et al July 2009). Serious long-term complication includes cardiovascular disease, stroke, chromic kidney disease, foot ulcers, and damage to the eyes.

 Diabetes is due to either the pancrease not producing enough insulin or the cells of the body not responding properly to the insulin produced. Shoback DG, Gardner D, eds. (2011).

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes.

1.1.1  Type of Diabetes Mellitus

Diabetes mellitus type 1 also known as type 1 diabetes: is a form of diabetes mellitus in which not enough insulin is produced. This results in high blood sugar levels in the body. The classical symptoms are frequent urination, increased thirst, increased hunger and weight loss. Additional symptoms may include blurry vision, feeling tired, and poor healing – symptoms typically develop over a short period of time (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). August 2014). The cause of type I diabetes is unknown. However, it is believed to involve a combination of genetic and environmental factors. Risk factors include having a family member with the condition (Kirkman, et al 16 June 2014).

The underlying mechanism involves an autoimmune destruction of the insulin – producing better cells in the pancreas. Diabetes in diagnosed by testing the level of sugar or A1C in the blood. Type 1diabetes can be distinguished form type 2 by testing for the presence of auto antibodies. There is no known way to prevent type 1 diabetes. Treatment with insulin is required for survival (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) July 2016) insulin pump. A diabetic diet and exercise are important parts of management.

1.1.2  Diabetes Mellitus type 2 (also known as type 2 diabetes): is a long – term        metabolic disorder that is characterized by high blood sugar, insulin      resistance, and relative lack of insulin. Common symptoms include          increased thirst, frequency urination, and unexplained weight loss.         Symptoms may also include increased hunger, feeling tired, and sores that    do not heal often symptoms come on slowly. Long-time complication from           high blood sugar include heart, disease, strokes, diabetic retinopathy which       can result in blindness, kidney failure, and pour blood flow in the limbs         which may lead to ampulations. The sudden onset of hyperosmolar hy-    perglycemic state may occur; however, ketoacidosis is uncommon (Pasquel,          F J; et al November 2014), Type 2 diabetes primary occurs as a result of      obesity and lack of exercise. Some people are genetically at risk           than   others. Type 2 diabetes makes up about 90% of cases of diabetes with     the           other 10% due primarily to diabetes mellitus type 1 and gestational         diabetes (WHO August 2013) in diabetes mellitus type 1 there is a lower       total level of insulin to control blood glucose, due to an autoimmune induced     loss of insulin – producing beta cells in the pancreas (Gardner et al 2011).          (Mackay et al 2014).

Gestational Diabetes: is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms, (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 31 July 2016).

However, it does increase the risk of pre-eclampsia, depression, and requiring a caesarean section. Babies born to mother with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and Jaundice. If untreated, it can also result in a stillbirth. If long term, children are at higher risk of being over weight, and developing type 2 diabetes. Gestational diabetes is caused by not enough insulin in the setting of insulin resistance. Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes and having polycystic ovarian syndrome. Diagnosis is by blood tests for those at normal risk screening is recommended  between 24 and 28weeks’ gestation. For those at high risk testing may occur at the first prenatal visit. Prevention is by maintaining a healthy weight and exercising before pregnancy. Gestational diabetes is treated with a diabetic diet, exercise, and possibly insulin injections. Most women are able to manage their blood sugar with a diet and exercise (Donovan Peter J. et al 2016). Blood sugar testing among those who are affected is often recommended four times a day. Breastfeeding is recommended as soon as possible after birth.

1.1.3  Sign and symptoms

The classic symptoms of untreated diabetes are weight loss, polyuria (increased urination), polydipsia (increased – thirst), and polyphagia (increased hunger). (Cooked DW, Plotnick L November 2008). Symptoms may develop rapidly (weeks or months) in type 1 DM, while they usually develop much more slowly and may be subtle or absent in type 2 DM. several other signs and symptom can mark the onset of diabetes although they are not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which leads to changes. A number of skin rashes that can occur in diabetes are collectively known as diabetic dermadromes (Hsieh, Arthur June 2016).

1.1.4  Causes  

Comparison of type 1 and 2 Diabetes

Feature  

Type 1 diabetes

Type 2 diabetes

Onset

Sudden

Gradual

Age at onset

Mostly in children

Mostly in adults

Body size

Thin or normal

Often obese

Ketoacidosis

Common

Rare

Autoantibodies

Usually present

Absent

Endogenous insulin

Low or absent

Normal, decreased or increased

Concordance in identical twins

50%

90%

Prevalence

-10%

-90%

1.1.5  What causes type 1 diabetes

Type 1 diabetes is caused by the immune system destroying the cells in the pancreas that make insulin. This causes diabetes by leaving eh body without enough insulin to function normally. This is called an autoimmune reaction, or autoimmune cause, because the body is attacking itself. There is not specific diabetes causes, but the following triggers may be involved.

(1) Viral or bacterial infection

(2) Chemical toxins within food

(3) Unidentified component causing autoimmune reaction. (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 2017). Underlying genetic disposition may also be a type 1 diabetes cause.

1.1.6  Type 2 Diabetes Causes

Type 2 diabetes causes are usually multifactorial. More than one diabetes cause is involved. Often the most over whelming factor is a family history of type 2 diabetes. This is the most likely type 2 diabetes cause. There are a variety of risk factors for type 2 diabetes any or all of which increase the chances of developing the condition. Those include:

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